Now that we know who the final two candidates for the Presidency are we can start fighting about who is going to be better for our country. Focusing on the health care issue, I feel that the best candidate just lost (Clinton,) and that the second best is Barack Obama. No, I am not a Democrat. In fact, I feel both parties are puppets in the hands of Big Business, much like it was in America at the time of the “Robber Barons,” when Teddy Roosevelt carried a big stick.

No, I am not complaining about fascists governments, where big corporations practically dictate how elected officials behave. I feel this is the way it has always been in the history of the world. Within a few years of starting any form of government, big business and the wealthy get in bed with government. To “kick against the pricks” (biblical sharp spikes to keep cattle in line to the slaughter, not the street meaning) is unwise, especially when we don’t understand the human tendency to respect our alpha dogs: the rich, the famous and the powerful.

These natural forces have contributed to the chaotic situation we have in health care: how could they not have? Health care is run by big businesses and corporations that have their long fingers in the political process and do not want to lose their power: insurance companies, pharmaceuticals, the AMA and many industries that produce expensive and less than ideal gadgets to care for people (mammograms, bone densitometries, surgery equipment, etc,) at the expense of cheaper modalities, like teaching patients one-on-one about TLC, “Therapeutic Lifestyle Changes.”

I remember vividly crying in the Jefferson monument when I read his statement about opposing tyranny over the hearts of men. But, since my high school education in Idaho, I had misunderstood the nature of the debate that Jefferson and John Adams sustained through most of their political careers. Encouraged by our public schools, most of us have sided with the more colorful, handsome, powerful, French-leaning Jefferson and his populist message. Like me, most of us felt that Adams was a rigid New Englander who favored the rich, not the common folk. Thanks to Mr. McCollough’s recent work, I have changed my views and “turned coat.”

Now I see Jefferson, the slave owner, as somewhat idealistic and not as well grounded in reality as Adams was. While Jefferson made quite a splash with his “government for the people, by the people and of the people,” the more austere and frugal non-slave owner Adams maintained that there would always be wealthier people in any society who would naturally tend to abuse their positions of power and influence to curtail the freedoms of the common folk. Realistically, he maintained that the rule of law was the best way to keep those tendencies from overwhelming the more humble segments of our society.

Even though most modern countries have left behind aristocratic forms of government, I feel that their powerful descendants never relinquished power. Their wealth and assets stayed in their families, and so did their powerful influence in their respective countries’ affairs. They have done so, some times covertly and often overtly. Most of these families are internationally related, which has fueled globalization, under the guise of joining people together for us commoner’s benefits.

Again, I am not complaining: this is human nature. Tongue in cheek, the journal Science has proposed that “homo sapiens” be changed to “homo economicus.” I agree. In fact, John Adams says it best: business is a grand and noble enterprise.” (“The Wealth of Nations.”) However, he also stated that “most of the world troubles come from somebody not knowing when to stop and be content.” (“Theory of Moral Sentiment.”)

It is in our nature to trade and barter. Even daily personal communications and relationships are a form of commerce, if you will. If we can do it with respect for one another, protected by the rule of law, it does not matter what color we are, what society we live in, what sex, or age, or even whether we like each other or not (it would be nice if we did…)

With these thoughts in mind, I have been deeply moved to see Senator Obama win the Democratic Party’s nomination, about the same time that I finished reading his most favorite book, “Team of Rivals,” which talks about Lincoln’s leadership style. Hopefully senator Obama will adopt the same lofty ideals if he is elected President, and surround himself with the brightest leaders in the country, from both parties, including those who have openly criticized him during the campaign, including senator Clinton. (That Lincoln was one of the most prominent Americans to warn us that powerful special interests could jeopardize our democracy is very interesting to me.)

I feel that senator Obama’s election is a hopeful reflection of how Adams and Jefferson together helped shape our country: yes, we do have a government of the people, for the people and by the people,” and the rule of law has made it so. But, our democracy is still in peril of being swallowed up by corporations, the military complex and who knows what other groups who will always attempt to impose their special interests by pushing their agendas through our sacred halls of government. Senator Obama’s election is a grand example that there is still hope for us common folk, even though blue collar workers may view him as a typical Harvard-elitist.

Also, I am delighted to see a man of mixed racial background achieve this position in our country for personal reasons. I, too have a mixed racial background. Growing up and well into my young adulthood, my background was a source of much turmoil and conflict. But, as I matured, I see such a background as an asset, even though I occasionally experience a cold handshake, a condescending stare and, thankfully, a rare outright racial putdown. Today, my friends and I joke about my Chilean, Basque and French ancestry, with the secure knowledge that I am an American first and foremost. I wish I could say that such a mixed heritage has not been problematic for some of my patients. But, I have solid evidence that a significant number of complaints about my practice, while couched on billing, miscommunication and my failed attempts to lighten up dealings with humor, are veiled displays of lack of respect because of my skin color.

But I digress.

Senator Obama’s historic run for the Presidency touches “half-breeds” like me in a very personal way. But, if you are 100% white, or of another race, I hope that you too find his unprecedented success inspiring. After all, it is an awe-inspiring example, as he puts it, of our quest for a “more perfect Union.”

Who knows… we may even get a health care system that is better, more democratic, and more in keeping with the rule of law, instead of the covert and overt health care system we have that clearly favors special interests. Even though the ‘business of America is business,” our next President’s administration would do well to return to solid principles of government, like the Roman “salus populi suprema lex,” or “the health of the people is the supreme law of the land.” Perhaps we may shine a more discriminatory light on the Roman dictum that now rules, “bread and circus.” If the powerful wish to control the masses they make food and entertainment readily available and even addicting, so that people think themselves to be free because they can choose between many different brands of bread and circus, while remaining ignorant of key social issues that have the most impact on their lives.

As November approaches, let us vote for the candidate that we feel is best prepared to stand up for the rule of law so that we the people may have better health and a better chance of a successful pursuit of happiness. For me, that means senator Obama. But, I won’t hold my breath that he will drive the more Darwinian money changers from our temples of commerce.

Senator Obama is a socialist, just short of espousing Marxism. This country was not built on socialism. He is also associates with radicals. That is enough to cause me to vote against him regardless of whatever lofty management styles he says he will follow. His ideas are faulty and deceptive. We may have weaknesses in our current capatilistic system but lets not exchange it for a system that undermines individual responsibility and promises cradle to grave goverment care. Politicians that imply that government has its own money and that they will parcel it out to those that deserve it when they get elected are the ultimate deceivers. Government has no money except that which it takes from the people. Look at the medical care systems of England and Canada. Do you really believe that government does anything very well? Why government as a solution? I grew up under socialized medicine as a dependent of airman in the U.S. Military. I saw my mother clean the floor on her hands and knees around my brother’s bed because it was so filthy. Don’t be so naive as to believe socialism is the answer to anything.

No, I don’t think government is the answer, not when government is in bed with big business. In its pure form, government IS the answer. But, as you correctly point out, we don’t have that, any more. Without government, we would still have children working, women and minorities deprived of voting rights and a whole lot more social ills that a Darwinian, Capitalistic system does not address.

Your answer reflects the typical reflexive, learned response to attack those who have different views, without defining what GOVERMENT is, or defining any other construct or idea in order to have a civil discussion. In my opinion, this is exactly what those in control wish: to divide us, the people, with futile, emotional discourse on who is right: republicans or democrats. If you read my blog again, you will see that I feel they are both controlled by the same elite rulers. I have good evidence that those in control FINACE both parties, so that no matter who wins, they still have control. So, attacking each other is exactly what they want to see.

Did you know that Karl Marx was welcome with open arms on Wall street? Yes, J.P. Morgan, Rockefeller, and many other pillars of capitalism saw the advantage of polarizing people so that they would pay no attention to the man behind the curtain. They FINANCED Marx’s activities when the Ruskies were about to assume a democratic government under Karanski’s people. So, Lenin was able to take over.

I am not a socialist, neither do I think that providing health care to those who can’t get it qualifies one as socialist. Surely you are not happy with the present system of health care?

I still wish to find some common ground with you : No, I don’t think that the “revolving door” government we have now is the answer. When a government employee leaves government, we /she goes to work for a big corporation, and vice-versa. So, we are left with very little if any true representation. The feedback I get is that it is extremely hard to reach our elected officials, unless we have contributed to their campaigns. But, if we are able to hire lobbysts and send sizable checks for their election funds, access is a bit easier.

Ultimately, as I concluded my initial blog, I am not holding my breath that Obama or McCain will be able to change the present state of affairs. If you believe that any other candidate but Obama is going to restore government to what our enlightened Founding Fathers had in mind, I fervently hope you are right. I would vote for such a person…

Thanks for your measured response and thoughtful ideas. Here is more of my reflexive response given in another forum. I do not see my comments as an attack on what others think who have different views. My goal is to get to the truth. I believe there are true government principles just as there are in true principles in medicine and every other discipline. Here’s what I wrote in a discussion over whether Obama is an elitist:

I mean why argue over things like who is an elitist and who lied last– what favored group of people have been wronged or whether they are likeable or not. What about the truth? The truth is that Hillary and Obama are both socialists. Many or all of their ideas come straight out of Karl Marx. This country was not built on socialism. Sadly, we seem to have reached the point where the electorate is willing to buy into which ever candidate can promise them the most. They are not being told the truth (there is that word again), only what they want to hear. If people are told that government has an inexhaustible supply of money and that other people have been holding them down and suppressing them, in effect, teaching them class warfare and that they as candidates will get even for them. The people are being told lies. There are such things as true government principles. The more we lean toward socialism the farther away we are from those principles. Liberalism and socialism are all about power, not truth. Teach people that you will take care of them from cradle to grave and that you need that candidate to make it work and you get someone to vote for you at first and then encircle them with a little more socialism and drag them down a little at a time. It is a sad fact of history that when the people believe they have the key to the treasuryof a country it is too easy to forget about self responsibility, entrepreneurship, and doing as Jack Kennedy exhorted, “Ask not what your country can do for you, ask what you can do for your country.” Hillary and Obama regularly tell people what they are going to give them that which is rightfully theirs–if they can only get in power. But government has no money of its own– only that which it takes from the people. In other words they sell the idea that tax cuts were essentially given only to the rich. Wrong again. Or, I should say untruthful. If you are going to give any tax cuts at all you must by definition include a lot of so called rich people because the statistics show that the top 5% of earners pay 50% of the taxes in this country.http://www.taxfoundation.org/news/show/746.htmlBut will you ever hear a candidate tell the truth about that. No, just the opposite and people who don’t read and are not informed take it in hook line and sinker when a candidate who seems very intelligent and ‘elite’ tells them that they are getting all the burden and the ‘rich’guys are getting away scot free so elect me and I will help you get even. Heck, their are people who will read the facts and still not believe them because some candidate sways them by telling them a convenient sophistry or out right lie. But it’s all about power. What is the next step below socialism? It is a slippery slope. Whatever it is it is not good because it is simply not based on truth. “A government that can give you everything you want is powerful enough to take everything you’ve got” someone once said. We have to stop spending ourselves into oblivion. If we cut taxes lets cut spending. We cannot make everyone rich by increasing taxation. It just doesn’t work that way. Another truth. Why aren’t these things self evident? Its not just a matter of opinion so that it will work several different ways. Just because you believe there are inequities in life you can’t force things to be other than they really are. The way you want them to be— because true government principles are underpinned by truth. Why don’t we hold all candidates up to the light of truth and weed out those who lie to us like Hillary and Obama. Like Abe Lincoln said,” You can fool some of the people all the time, and all of the people some of the time, but you cannot fool all of the people all of the time.” May that statement be true, I pray, for our sakes as a people and as a nation.

Like you, I am not holding my breath for Obama or anyone else in this election cycle to bring us a better approach. Its a sad fact that most of us end up voting against a candidate rather than for someone. My only hope is that McCain will contain government spending and appoint judges that will uphold the constitution and stop the onslaught of liberalism that is so pervasive in the news right now in California. I alsohope he will get us on a course to energy independence. Pebble bed nuclear reactors as being built by China and South Africa in an aggressive way. They cannot melt down and produce hydrogen as a by product. But where do we hear of leadership in any important area?Certainly not from the left. The Republican’s completely blew it when they had the power to lead. Now we get nothing but misguided ideas about change. The wrong kind of changes in my view. Give me a black president. Give me a woman president. Just don’t give me the most extreme liberal in the Senate together with his radical background and associates. I just think McCain is the lesser of two evils.

Bear with me. I’m a novice at the type of medicine you are practicing, though I welcome any fresh approach that avoids the current system, which I see only as applied organic and physical chemistry, the application of such compounds or solutionas as might, on the basis of ten minutes or less of patient study, make him feel better; or as an alternative, cut (surgery) and run. The biggest problem with medicine these days is in the people who practice it, however they are organized, and however how much money they make at it.

At any rate, I’m not a novice to political philosophy, and I have to admit that I see in your essay some conviction that “if we would only set up our health care system along naturopathic (TLC) lines, everything would be rosy.”

Well, maybe things would be a lot better, but people would still get injured or sick, still die, still take drugs, still get old, still want to look younger, etc. We can’t change that by nationalizing the drug industry or by running all health care from the top, by government rule and administration.My own conviction is that the best tonic for a broken (or crooked) practitioner, or drug manufacturer, or medical device distributor, is competition. Government can play a very salutory role in that, by ensuring a free market and by fostering innovation. Leave the day-to-day operations to the mnarket.

There’s that word above: “salutory”. My Jesuit training choked at the exceedingly narrow translation you gave to “salus”, in “salus populi suprema lex.”. Now I don’t pretend to know just what Cicero had in mind, but I’m sure it was much more broad than physical or mental health. I’d say: “well being”. As applied to government, Locke clearly had it pegged as the responsibility of governors to ensure physical safety of the population (Rome did this very well for centuries), and to permit them an opportunity to fulfill their own basic individual needs and wants. Locke also thought that a constitutional monarchy was perfectly capable of doing this, if that’s what the people wanted. What “salus” clearly does not mean is: “the greatest good for the greatest number.” We don’t shoot our most badly wounded soldiers on the battlefield, or restrict immunizations to those who have the best chance of surviving the epidemic without them.

Similarly, people clearly want to make sure that health care is more democratic. Medicare is abysmally expensive, but it takes care of the vast majority of old people. MEDICAID, S-CHIP, FEHBP, TRICARE, and other government programs are less effective, and they have a lot of lessons on how to distribute health services. But I rail at the idea that the problem is lack of insurance. You have a lot more ER experience than me, but I think insurance-based schemes are crazy. Right now we deliver health services to the indigent in ERs at wholesale prices. We’ll add a resident here, an RN or Tech there in response to the needs of the community. If we were to give the indigent carte blanche to get these services at retail, do you have any idea what it would cost? Of course the insurance companies want us to have a Hillary-type sheme based on insurance. They stand to make hundreds of billions of dollars!

Maybe Obama can provide the impetus for an agreed solution to all that ails us in the country and the world. For me the jury’s still out on that. But I enjoyed your post. Thanks.

Health care in the USA follow an acute care model, which is very successful. The problem is that the same acute care solutions are applied to chronic care. There is widespread consensus that we fail miserably in the latter, which is best addressed by educating people to assume responsibility for their own care through prevention, nutrition and attention to mind-body issues. Many articles have shown that by emphasizing these principles, which are amply documented to be successful, we may cure 85% of chronic diseases. If that is too rosy, so be it (AChronic Disease: the need for a new clinical education,@ JAMA 2004;292:1057.)

Competition in health care is not working in the USA today. The reasons are political and highly debatable. The result is that low tech solutions are preempted by a system that prefers more “bells and whistles.” (“Gizmo Idolatry,” JAMA 2008;299:1830, “Bleeding the patient: the consequences of Corporate Health Care,” JAMA 2002;287:2289)

As for the “Salus populi comments,” please, read this article: “Salus Populi Suprema Lex,” American J. Public Health 2001;91:689

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